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Impact of an electronic hard-stop clinical decision support tool to limit repeat Clostridioides difficile toxin enzyme immunoassay testing on test utilization

Published online by Cambridge University Press:  24 October 2019

Jennie H. Kwon*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Kimberly A. Reske
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Tiffany Hink
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Ronald Jackups Jr
Affiliation:
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
Erik R. Dubberke
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Jennie H. Kwon, DO, MSCI, E-mail: [email protected]

Abstract

We performed an intervention evaluating the impact of an electronic hard-stop clinical decision support tool on repeat Clostridioides difficile (CD) toxin enzyme immunoassay (T-EIA) testing. The CD testing rate and number of admissions with repeat tests decreased significantly postintervention (P < .01 for both); the percentage of positive tests was unchanged (P = .27).

Type
Concise Communication
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part as an abstract (no. 2086) at IDWeek 2016 on October 29, 2016, in New Orleans, Louisiana.

References

Dubberke, ER, Han, Z, Bobo, L, et al. Impact of clinical symptoms on interpretation of diagnostic assays for Clostridium difficile infections. J Clin Microbiol 2011;49:28872893.CrossRefGoogle ScholarPubMed
Manabe, YC, Vinetz, JM, Moore, RD, Merz, C, Charache, P, Bartlett, JG. Clostridium difficile colitis: an efficient clinical approach to diagnosis. Ann Intern Med 1995;123:835840.CrossRefGoogle Scholar
Peterson, LR, Robicsek, A. Does my patient have Clostridium difficile infection? Ann Intern Med 2009;151:176179.CrossRefGoogle ScholarPubMed
Litvin, M, Reske, KA, Mayfield, J, et al. Identification of a pseudo-outbreak of Clostridium difficile infection (CDI) and the effect of repeated testing, sensitivity, and specificity on perceived prevalence of CDI. Infect Control Hosp Epidemiol 2009;30:11661171.CrossRefGoogle ScholarPubMed
Stevens, V, Dumyati, G, Fine, LS, Fisher, SG, van Wijngaarden, E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53:4248.CrossRefGoogle ScholarPubMed
Hunt, DL, Haynes, RB, Hanna, SE, Smith, K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998;280:13391346.CrossRefGoogle ScholarPubMed
Cardona, DM, Rand, KH. Evaluation of repeat Clostridium difficile enzyme immunoassay testing. J Clin Microbiol 2008;46:36863689.CrossRefGoogle ScholarPubMed
Hink, T, Burnham, CA, Dubberke, ER. A systematic evaluation of methods to optimize culture-based recovery of Clostridium difficile from stool specimens. Anaerobe 2013;19:3943.CrossRefGoogle ScholarPubMed
Quan, H, Sundararajan, V, Halfon, P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:11301139.CrossRefGoogle ScholarPubMed
Burnham, CA, Carroll, KC. Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev 2013;26:604630.CrossRefGoogle ScholarPubMed
Deshpande, A, Pasupuleti, V, Patel, P, et al. Repeat stool testing to diagnose Clostridium difficile infection using enzyme immunoassay does not increase diagnostic yield. Clin Gastroenterol Hepatol 2011;9:665669.e661.CrossRefGoogle Scholar
Mohan, SS, McDermott, BP, Parchuri, S, Cunha, BA. Lack of value of repeat stool testing for Clostridium difficile toxin. Am J Med 2006;119:356.e357–358.CrossRefGoogle ScholarPubMed
Luo, RF, Spradley, S, Banaei, N. Alerting physicians during electronic order entry effectively reduces unnecessary repeat PCR testing for Clostridium difficile . J Clin Microbiol 2013;51:38723874.CrossRefGoogle ScholarPubMed
Aichinger, E, Schleck, CD, Harmsen, WS, Nyre, LM, Patel, R. Nonutility of repeat laboratory testing for detection of Clostridium difficile by use of PCR or enzyme immunoassay. J Clin Microbiol 2008;46:37953797.CrossRefGoogle ScholarPubMed
Nistico, JA, Hage, JE, Schoch, PE, Cunha, BA. Unnecessary repeat Clostridium difficile PCR testing in hospitalized adults with C. difficile–negative diarrhea. Eur J Clin Microbiol Infect Dis 2013;32:9799.CrossRefGoogle Scholar
Quan, KA, Yim, J, Merrill, D, et al. Reductions in Clostridium difficile infection (CDI) rates using real-time automated clinical criteria verification to enforce appropriate testing. Infect Control Hosp Epidemiol 2018;39:625627.CrossRefGoogle ScholarPubMed